At a glance: Haiti

Foot soldiers in Haiti’s fight against cholera

Working in their own communities, TEPAC water and sanitation agents are foot soldiers in Haiti’s fight against the largest cholera outbreak of the century.

By Michelle Marrion

As Haiti struggles to overcome the largest cholera outbreak of the century, water and sanitation agents are working in their own communities to promote best practices and provide vital support to combat spread of the disease.

PORT-AU-PRINCE, Haiti, 18 March 2014 – Jean Petit Marseille, Coordinating Engineer in Central District for Haiti’s department of water and sanitation (DINEPA), believes so strongly in the work of his team that he calls them “foot soldiers” in the fight against cholera. On the ground, these troopers for community sanitation and drinking water are known as TEPAC (the French acronym for Techniciens en Eau Potable et en Assainissement pour les Communes).

But by either name, on any given day, when Mr. Marseille treks alongside TEPAC agents through the mountains of Haiti, a small crowd of community members usually starts to trail behind them, calling out to express their need for water purification tablets in their homes.

Hitting the trails in these rural areas is an essential aspect of investigating outbreaks and pinpointing sources of contamination in the country as it struggles to overcome the largest cholera outbreak of the century. In 2010, the year of the onset of the epidemic, Haiti reported more cholera cases than the entire continent of Africa, which is one thousand times the size of Haiti.

The agents distribute critical supplies like water purification tablets – critical since cholera-causing bacteria spread through contaminated water and food.

The fight against cholera

UNICEF’s strategy to support Haiti’s national plan of action against cholera is threefold, involving coordination, response and prevention. Effective coordination among all stakeholders leads to faster response and expanded prevention activities.TEPAC agents are responsible for implementing the plan’s response aspect – crucial not only to save lives, but also to limit cholera transmission and to prevent the current outbreak from becoming endemic.

According to UNICEF Haiti Cholera Coordinator Claudia Evers, “Cholera does not kill if it is treated within 48 hours. To ensure rapid response activities, an efficient and well-consolidated coordination in the field is important. It means all actors need to speak to each other to make sure everybody knows who is doing what.”

Eyes and ears on the ground

TEPAC agents are especially well-suited for implementing timely and coordinated responses. “They’re the ones in the community, living with the people,” explains Mr. Marseille, “so they’re the first ones to know what’s going on. “

This proximity – and awareness of the first-known cholera cases – allows for immediate coordination of response activities with local health officials, helping to prevent intense outbreaks or to quell those that have already erupted.

Response activities include household visits, during which supplies like water purification tablets are distributed – critical since cholera-causing bacteria spread through contaminated water and food.

Going door-to-door in rural areas, the agents become aware of cholera cases when they first emerge. This allows for immediate coordination of responses that help quell outbreaks and prevent new ones.

Agents also impart their knowledge of hygiene practices that mitigate the risk of exposure to cholera. Handwashing is one simple approach. Germs also spread via open defecation, but in areas still requiring latrines, limiting exposure of that sort can prove a more complex endeavor. The agents share tips on how communities should best protect themselves until latrines can be built.

Reaching the unreachable

TEPAC agents’ strong ties to the population at large also improve the link between community members and the government organizations that can respond to their needs. By going door-to-door, interacting with community members, TEPAC agents learn which areas lack latrines, for example. That information is invaluable in discovering how to best direct support in the area of water, sanitation and hygiene (WASH).

In 2014, planned WASH activities will reach 450,000 people in Haiti’s most affected areas. “That’s the kind of coordinated response we want in the district that will allow us to reach areas everyone thought were unreachable,” says Mr. Marseille.

With the financial support of UNICEF and DINEPA, TEPAC agents are now employed in every Haitian commune. Reported cholera cases in Haiti decreased from more than 100,000 reported cases in 2012 to 58,505 suspected cases of cholera reported by the Epidemiological Department of the Ministry of Health for 2013. This is evidence of the gains TEPAC’s intervention has already helped to achieve – and augurs the progress yet to come.